Individual
BAILIE WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
4956 N CHRISTIANA AVE APT 3, CHICAGO, IL 60625-5079
(828) 361-9423
Mailing address
4956 N CHRISTIANA AVE APT 3, CHICAGO, IL 60625-5079
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
18-59977
IL
Other
Enumeration date
08/02/2018
Last updated
08/02/2018
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